The Rhode Island Young Adult Prescription and Illicit Drug Study (RAPIDS): Responding to Fentanyl and Associated Harms

项目总结 美国正在经历历史上最严重的吸毒过量流行。这场危机已经极大地 强效合成阿片类药物的出现，特别是芬太尼和相关类似物的出现，加剧了这种情况。芬太尼 现在是海洛因中最常见的掺杂物，并已被鉴定为假冒处方药和非法 可卡因等毒品。只有少量的芬太尼(相当于几粒盐)才能导致 致命的服药过量。因此，它在非法药物供应中的存在对那些在不知情的情况下消费的人构成了巨大的风险。 物质。在美国，超过30%的药物过量死亡是由合成阿片类药物(主要是芬太尼)造成的， 然而，几乎没有制定出旨在降低芬太尼过量风险的策略。在这个随机化的 对照试验，我们将测试一种新颖的、基于理论的芬太尼过量教育和咨询的有效性 包括“带回家的”快速芬太尼试纸的干预措施，以降低过量服药率。这项研究 将在罗德岛州进行，该州的过量服药率在全国排名第十，超过 与药物有关的死亡有一半是由芬太尼引起的。我们将招募以社区为基础的500名年轻人样本 年龄在18至35岁之间，使用海洛因或非法兴奋剂、假冒处方药或注射毒品。在 干预臂，个人将参与Rapids干预，一种新型的芬太尼过量教育 和咨询计划，提供有关芬太尼危险的信息，激励性访谈 增加使用快速芬太尼试纸的意愿，并参与减少伤害的行为，动手 关于如何使用条带的培训，以及讨论和角色扮演如何实施减少危害的机会 行为。被随机分配到对照组的患者将接受标准的过量服药教育和纳洛酮 分发。主要结果将是在12个月的随访中观察到的自我报告的过量服药率- 上行期。我们将用致命性和非致命性过量事件的数据补充主要终点 是通过疾控中心资助的全州过量用药监测系统确定的。这项研究的具体目的 目的是：1)评估快速干预在降低以下年轻人服药过量比率方面的有效性 使用药物；2)检查过量服药率的降低在多大程度上是通过增加 关于芬太尼、快速芬太尼测试和危害的信息、动机、行为技能和自我效能 减少实践；以及3)探索与关键参与者相关的治疗效果是否存在异质性 特点。我们的研究非常有意义，因为它直接解决了如何 面对不断升级的芬太尼疫情，最好减少年轻人服药过量的风险。这项研究是 极具创新性，因为这将是美国第一个测试一种新型过量药物疗效的设备 教育和咨询干预，结合带回家的快速测试技术来检测暴露 在吸毒人群中使用芬太尼。总而言之，这项研究的结果将显著 加强公共卫生努力，防止年轻人服药过量。

PROJECT SUMMARY The United States is experiencing the worst drug overdose epidemic in history. This crisis has been greatly exacerbated by the emergence of potent synthetic opioids, particularly fentanyl and related analogs. Fentanyl is now the most common adulterant in heroin and has been identified in counterfeit prescription pills and illicit drugs such as cocaine. Only a small amount of fentanyl (the equivalent of several grains of salt) can lead to a fatal overdose. Its presence in the illicit drug supply thus poses great risk to those who unknowingly consume the substance. Over 30% of all drug overdose deaths in the US are due to synthetic opioids (mostly fentanyl), yet few strategies aimed at reducing risk of fentanyl overdose have been developed. In this randomized controlled trial, we will test the efficacy of a novel, theory-based fentanyl overdose education and counseling intervention that incorporates “take-home” rapid fentanyl testing strips in reducing rates of overdose. The study will be conducted in Rhode Island, a state with the tenth highest overdose rate in the nation and in which over half of drug-related deaths are due to fentanyl. We will recruit a community-based sample of 500 young adults aged 18 to 35 who use heroin or illicit stimulants, counterfeit prescription pills, or inject drugs. In the intervention arm, individuals will participate in the RAPIDS intervention, a novel fentanyl overdose education and counseling program that provides information about the dangers of fentanyl, motivational interviewing to increase willingness to use rapid fentanyl test strips and engage in harm reduction behaviors, hands-on training on how to use the strips, and opportunities to discuss and role-play how to implement harm reduction behaviors. Individuals randomized to the control arm will receive standard overdose education and naloxone distribution. The primary outcome will be the rate of self-reported overdose observed over the 12-month follow- up period. We will supplement the primary endpoint with data on fatal and non-fatal overdose events ascertained through a CDC-funded statewide overdose surveillance system. The Specific Aims of this study are to: 1) Assess efficacy of the RAPIDS intervention in reducing rates of overdose among young adults who use drugs; 2) Examine the degree to which reductions in rates of overdose are mediated by increases in information, motivation, behavioral skills, and self-efficacy regarding fentanyl, rapid fentanyl testing, and harm reduction practices; and 3) Explore whether there is heterogeneity of treatment effect related to key participant characteristics. Our study is highly significant because it directly addresses crucial knowledge gaps in how to best reduce risk of overdose among young adults in the face of an escalating fentanyl epidemic. The study is highly innovative because it will be the first in the United States to test the efficacy of a novel overdose education and counseling intervention that incorporates take-home rapid testing technology to detect exposure to fentanyl in a population of people who use drugs. In sum, the results of this research will significantly enhance public health efforts to prevent overdose among young adults.